Aortic Dissection - Endovascular Intervention

A 36yrs old male approached Dr. C. Raghu at Prime Hospitals about 4 weeks ago with a history of leg pain and breathless while walking. Previous investigations by doctors at Vijayawada & Guntur had revealed a tear in the aorta (the large blood vessel that leads from the heart and carries blood to the rest of the body.) the aorta originates from the outlet of the heart (Left Ventricle), and ascends in the chest to an arch where blood vessels branch off to supply blood to the arms and head, During its subsequent descent in the chest and abdomen, its supplies blood through multiple branches to the stomach, intestine, kidney and spinal cord, the wall of the aorta is very thick and is designed to withstand high pressures when the heart pumps blood to the various parts of the body. In a situation of aortic dissection, a tear happens within the wall of the aorta and in many cases it burrows through the various layers leading to a false channel which reduces blood supply through the true lumen to the various organs of the body. the major cause of the aortic dissection in more than 70% of the cases is High Blood Pressure. Uncommon causes for aortic dissection include pregnancy, trauma to the chest especially in a car accident, and Syphilis. Untreated aortic dissection is a potentially fatal illness. Till recently the treatment for aortic dissection used to be surgery involving replacment of a large segment of aorta with a synthetic tube, but unfortunately this is a very major procedure associated with high morbidity, reduction in blood supply to various organs of the body, risk of death, paralysis of both lower limbs, etc. In addition, the surgery requires a highly skilled surgeon and is not performed in many centers. Hence about six surgeons both a Vijayawada and in Hyderabad have refused to carry out the procedure and suggested that the patient continue on medication only. At this juncture, they approached Dr. C. Raghu, Chief Cardiologist, Prime Hospitals, Hyderabad, for a possible therapeutic approach. A repeat multi-slice CT scan of the aorta and its branches showed fresh blockage of arteries secondary to extension of dissection supplying intestine, left kidney and left lower limb, leading to serious compromise of these organs. Considering the person's age and presence of Hypertension and very long dissection extending across the entire length of the aorta, Dr. C. Raghu felt that this was not an ideal case for surgery, but instead recommended stenting of the aorta for this aortic dissection. On the 5th of December 2010 this procedure was successfully performed at Prime Hospital, Hyderabad, with a good result. The Patient has recovered after surgery and is doing very well. Stenting of aorta dissection has been performed for the first time in the state of Andhra Pradesh in such a complex situation. Surgery in this patient would have endangered his life and definitely would have resulted in a long hospital stay. Usually patients with a complex aortic dissection are managed medically because of the lack of experienced surgeons or cardiologists to perform these procedures. This is the first experience of performing aortic stenting in such a serious subset of patients.

Category:

Science & Technology

Tags:

• dissection
• aorta
• endovascular
• stentgraft

[polly2631]

Can someone tell me the point to the main surgeon wearing the mask if he is going to expose his nose during surgery?